Provider Demographics
NPI:1124759188
Name:ZAVARELLI, DANIELLE ANN (PA)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:ANN
Last Name:ZAVARELLI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:ANN
Other - Last Name:ZAVARELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:168 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4418
Mailing Address - Country:US
Mailing Address - Phone:917-319-8701
Mailing Address - Fax:718-462-8000
Practice Address - Street 1:168 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4418
Practice Address - Country:US
Practice Address - Phone:917-319-8701
Practice Address - Fax:718-462-8000
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008175-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant